Skip to main content

Worker's Compensation

Worker's Compensation is a claim for which payment is made by an employer for medical services provided to an employee for an injury or illness occurring in the course of the individual's employment.

Centra will submit your workers' compensation claim directly to your employer, or other payer as directed by the employer. Your employer may require you to provide additional information regarding your injury or illness. Delays in providing this information can result in denial or reduction in benefits. Please respond promptly to these requests.

To verify the employer's responsibility for payment, it is recommended that the patient obtain an authorization from worker's compensation payment from the employer.

You may be responsible for payment of services your employer determines are not approved under workers' compensation. If you file an appeal through Virginia Workers' Compensation Commission, Centra will hold your claim pending the outcome. Centra will also submit your bill to your group insurance carrier if you provide the information.

Worker's Compensation instructions

Injured employee responsibilities

  1. Give notice of injury to your employer as soon as possible.
  2. File a claim with the Workers' Compensation Commission within two years from the date of the accident or the date the doctor diagnoses an occupational disease.
  3. Select a doctor from a panel of three provided by the employer/carrier. Do not change doctors without employer/carrier permission or after a hearing by the Commission.
  4. Seek and accept employment if released to light duty, and cooperate with "rehabilitation counselors."

Types of Worker's Compensation injuries

Employees are entitled to receive compensation for an "injury by accident" or an "occupational disease."

In order to be covered, an "accident" must occur at work or during a work-related function, be caused by a specific work activity, happen suddenly at a specific time. (Injuries incurred gradually or from repetitive trauma are not covered, although certain diseases caused by repetitive trauma are covered.)

In order to be covered, a disease must be caused by the work, and not be a disease of the back, neck, or spinal column.

Minor injuries

If you suffered a minor injury at work, you must file a claim with the Workers' Compensation Commission within two years from the date of the accident or any right to benefits may be lost.

Claims for an occupational disease must be filed within two years from the date the doctor tells the employee the disease is work related, or five years from the date the employee was last exposed to the work condition causing the disease, whichever is sooner. (Certain diseases, such as asbestosis, byssinosis, silicosis and coal workers' pneumoconiosis have different limitation periods.)

If after returning to work, you are again disabled, you must file a claim within two years of the date for which you were last paid compensation under an award. (This is called a "change in condition.") Payment only goes back 90 days from the date of filing with the Commission.

Even if the employer has paid lost wages or provided medical care, it is still the employee's responsibility to file a claim with the Commission. If no claim is filed with the Commission or no award entered, the employer may stop paying medical expenses or wage loss at any time.

The employer or carrier may get information from the employee to send to the Commission, but this is not the filing of the employee's claim. The employee must file a claim even if the employer filed reports with the Commission.

Denied claim procedure

The Workers' Compensation Commission makes the final decision whether the employer must pay for the injury or disease.

If the employer/carrier denies the claim or refuses to make certain payments, this does not mean you are not entitled to benefits. It only means that the benefits will not be voluntarily paid. The employee should then send a written request for a hearing to the Commission.

At the hearing, the employee must prove through testimony, witnesses and medical reports, that the injury or disease and disability were caused by the work. If the employee was released to light work, then the employee must submit evidence that he/she has actively sought work. This includes seeking employment at the pre-injury employer, registering with the Virginia Employment Commission and listing dates and places where applications for work were made.

The employee is entitled to have a lawyer at the hearing at his/her own expense. All attorneys' fees are subject to approval by the commission.

If you disagree with the written hearing opinion, you must notify the Commission in writing within 20 days after receipt of notice of such award that you are requesting a review of the decision.